| 11. |
- Fischer, U., et al.
(författare)
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Early versus Later Anticoagulation for Stroke with Atrial Fibrillation
- 2023
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Ingår i: New England Journal of Medicine. - 0028-4793. ; 388:26, s. 2411-2421
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe effect of early as compared with later initiation of direct oral anticoagulants (DOACs) in persons with atrial fibrillation who have had an acute ischemic stroke is unclear.MethodsWe performed an investigator-initiated, open-label trial at 103 sites in 15 countries. Participants were randomly assigned in a 1:1 ratio to early anticoagulation (within 48 hours after a minor or moderate stroke or on day 6 or 7 after a major stroke) or later anticoagulation (day 3 or 4 after a minor stroke, day 6 or 7 after a moderate stroke, or day 12, 13, or 14 after a major stroke). Assessors were unaware of the trial-group assignments. The primary outcome was a composite of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death within 30 days after randomization. Secondary outcomes included the components of the composite primary outcome at 30 and 90 days.ResultsOf 2013 participants (37% with minor stroke, 40% with moderate stroke, and 23% with major stroke), 1006 were assigned to early anticoagulation and 1007 to later anticoagulation. A primary-outcome event occurred in 29 participants (2.9%) in the early-treatment group and 41 participants (4.1%) in the later-treatment group (risk difference, -1.18 percentage points; 95% confidence interval [CI], -2.84 to 0.47) by 30 days. Recurrent ischemic stroke occurred in 14 participants (1.4%) in the early-treatment group and 25 participants (2.5%) in the later-treatment group (odds ratio, 0.57; 95% CI, 0.29 to 1.07) by 30 days and in 18 participants (1.9%) and 30 participants (3.1%), respectively, by 90 days (odds ratio, 0.60; 95% CI, 0.33 to 1.06). Symptomatic intracranial hemorrhage occurred in 2 participants (0.2%) in both groups by 30 days.ConclusionsIn this trial, the incidence of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death at 30 days was estimated to range from 2.8 percentage points lower to 0.5 percentage points higher (based on the 95% confidence interval) with early than with later use of DOACs. (Funded by the Swiss National Science Foundation and others; ELAN ClinicalTrials.gov number, .)
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| 12. |
- Li, J. J., et al.
(författare)
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Concurrent measurements of nitrate at urban and suburban sites identify local nitrate formation as a driver for urban episodic PM2.5 pollution
- 2023
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Ingår i: Science of the total environment. - 0048-9697. ; 897
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Tidskriftsartikel (refereegranskat)abstract
- Nitrate (NO3-) is often among the leading components of urban particulate matter (PM) during PM pollution episodes. However, the factors controlling its prevalence remain inadequately understood. In this work, we analyzed concurrent hourly monitoring data of NO3- in PM2.5 at a pair of urban and suburban locations (28 km apart) in Hong Kong for a period of two months. The concentration gradient in PM2.5 NO3- was 3.0 +/- 2.9 (urban) vs. 1.3 +/- 0.9 mu g m(-3) (suburban) while that for its precursors nitrogen oxides (NOx) was 38.1 vs 4.1 ppb. NO3- accounted for 45% of the difference in PM2.5 between the sites. Both sites were characterized to have more available NH3 than HNO3. Urban nitrate episodes, defined as periods of urban-suburban NO3- difference exceeding 2 mu g m(-3), constituted 21 % of the total measurement hours, with an hourly NO3- average gradient of 4.2 and a peak value of 23.6 mu g m(-3). Our comparative analysis, together with 3-D air quality model simulations, indicates that the high NOx levels largely explain the excessive NO3- concentrations in our urban site, with the gas phase HNO3 formation reaction contributing significantly during the daytime and the N2O5 hydrolysis pathway playing a prominent role during nighttime. This study presents a first quantitative analysis that unambiguously shows local formation of NO3- in urban environments as a driver for urban episodic PM2.5 pollution, suggesting effective benefits of lowering urban NOx.
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